2025 ICD-10-CM code J11.0
(Active) Effective Date: N/A Diseases of the respiratory system - Influenza and pneumonia (J09-J18) J00-J99 Feed
Influenza due to unidentified influenza virus with pneumonia.
Medical necessity is established by the presence of both influenza and pneumonia, as confirmed by clinical findings and diagnostic testing. This dual diagnosis justifies the medical intervention, including antiviral treatment, respiratory support, and management of complications like lung abscess.
Clinicians diagnose and treat influenza with pneumonia. It involves managing symptoms, providing supportive care (rest, hydration), administering antiviral medications (if appropriate), and sometimes antibiotics (if bacterial pneumonia coexists or develops as a complication). Monitoring respiratory function and oxygen saturation is crucial. In severe cases, patients may require hospitalization.
In simple words: This code signifies pneumonia along with the flu, where the specific flu virus hasn't been pinpointed.
Influenza due to unidentified influenza virus with pneumonia.If applicable, use additional code J85.1 for lung abscess.
Example 1: A patient presents with fever, cough, shortness of breath, and chest pain. Physical examination reveals lung consolidation. Laboratory tests confirm influenza, but the specific subtype isn't determined. The patient's condition worsens, and imaging shows pneumonia. J11.0 is assigned., An elderly individual develops a cough, fatigue, and fever during flu season. They test positive for influenza, but further subtyping isn't performed. Chest X-ray reveals signs of pneumonia. J11.0 is used to document the condition., A child exhibits flu-like symptoms followed by difficulty breathing and rapid breathing. They are diagnosed with influenza, but the specific strain isn't identified. Imaging confirms the presence of pneumonia. J11.0 is the appropriate code.
Documentation should include evidence of influenza (e.g., positive lab test, clinical findings), imaging results confirming pneumonia (e.g., chest X-ray), and details of associated symptoms (e.g., fever, cough, shortness of breath). If a lung abscess is present, it should also be documented.
** Excludes2: certain conditions originating in the perinatal period (P04-P96), certain infectious and parasitic diseases (A00-B99), complications of pregnancy, childbirth and the puerperium (O00-O9A), congenital malformations, deformations and chromosomal abnormalities (Q00-Q99), endocrine, nutritional and metabolic diseases (E00-E88), injury, poisoning and certain other consequences of external causes (S00-T88), neoplasms (C00-D49), smoke inhalation (T59.81-), symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- Specialties:Internal Medicine, Family Medicine, Infectious Disease, Pulmonary Medicine, Pediatrics
- Place of Service:Inpatient Hospital, Office,Emergency Room - Hospital, Urgent Care Facility, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home